What types of spine conditions are the most painful?

SCIATICA

If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have a protruding (herniated) disc in your spinal column that is pressing on the nerve roots in the lumbar spine. This condition is known as sciatica.

Sciatica may feel like a bad leg cramp, with pain that is sharp (“knife-like”), or electrical. The cramp can last for weeks before it goes away. You may have pain, especially when you move, sneeze, or cough. You may also have weakness, “pins and needles” numbness, or a burning or tingling sensation down your leg.

In rare cases, a herniated disc may press on nerves that cause you to lose control of your bladder or bowel, referred to as cauda equina syndrome. If this happens, you may also have numbness or tingling in your groin or genital area. This is an emergency situation that requires surgery. Phone your doctor immediately (AAOS, 2015).

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CAUSES

You are most likely to get sciatica between the ages of 30 and 50 years. It may happen as a result of the general wear and tear of aging, plus any sudden pressure on the discs that cushion the bones of your lower spine.

Sciatica is most commonly caused by a herniated disc. The gel-like center of a disc may protrude into or through the disc’s outer lining. This herniated disc may press directly on the nerve roots that become the sciatic nerve. Nerve roots may also get inflamed and irritated by chemicals from the disc’s nucleus.

Approximately 1 in every 50 people will experience a herniated disc at some point in their life. Of these, 10% to 25% have symptoms that last more than 6 weeks.

TREATMENT

Nonsurgical Treatment
The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks.

Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may also help. In addition, you may find it soothing to put gentle heat or cold on your painful muscles. It is important that you continue to move. Do not remain in bed, as too much rest may cause other parts of the body to feel discomfort.

Find positions that are comfortable, but be as active as possible. Motion helps to reduce inflammation. Most of the time, your condition will get better within a few weeks.

As soon as possible, start stretching exercises so you can resume your physical activities without sciatica pain. Your doctor may want you to take short walks and may prescribe physical therapy. Sometimes, you may need an injection in your spinal area with a cortisone-like drug.

Surgical Treatment
You might need surgery if you still have disabling leg pain after 3 months or more of nonsurgical treatment. A part of your surgery, your herniated disc may be removed to stop it from pressing on your nerve.

The surgery (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg.

PREVENTION

It’s not always possible to prevent sciatica, and the condition may recur. The following suggestions can play a key role in protecting your back:

  • Exercise regularly. This is the most important thing you can do for your overall health as well as for your back. Pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. Ask your doctor to recommend specific activities.
  • Maintain proper posture when you sit. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
  • Use good body mechanics. If you stand for long periods, rest one foot on a stool or small box from time to time. When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

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